Cautery in medieval surgery: a unique palaeopathological case

Cautery is a fundamental tool in the ancient and medieval surgery. We read in the Aphorisms of Hippocrates: "Those diseases which medicines do not cure, iron (the knife?) cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable". This sentence of the Father of Medicine was made its own by Roman Medicine and then by the Byzantine and Islamic surgical practice in the Middles Ages. However, bioarchaeological human remains that testify the use of the cautery are extremely rare. We present a unique, original case, dating back to the 11th century, recently discovered on the mummy of a Saint venerated in Lucca (central Italy). The mummified body of St. Davinus Armenian has been preserved for about 1000 years in the Basilica of San Michele in Foro in Lucca (central Italy). In the hagiographic sources, we read that Davinus, left from Armenian Kingdom, arrived in Lucca in the year 1050, after a long pilgrimage to Jerusalem and Rome. He died in a hospital annexed to the church of San Michele during a stop of the pilgrimage to Santiago de Compostela. The veneration of the body is already attested in the 11th-12th century. In 26-29 March 2018 a complete study of the body, including macroscopic and radiological examination (CT total body), revealed the natural mummy of a young man of about 25 years. Two traumatic lesions of the skull with long-term survival appeared: a superficial cutting wound on the left frontal bone (5 cm length, 0.5 cm wide), produced by a toothed blade, and an elliptical (2 x 1 cm) wound with depressed fracture, produced by a blunt weapon on the right coronal suture. Around the elliptical lesion, we noted a wider scar with thin margin (0.2 mm) describing a pentagonal shape, evidently caused by the application of a red-hot iron, a cautery with a pentagonal head. The cauteries had very variable shape, round, squared or polygonal (as in the present case), depending on their primary aim, as is documented the surgical treaty (al-Taṣrīf ) of Albucasis, the great Muslim surgeon of 10th-11th century, master and unyielding advocate of the cautery practise. It is the first time that the use of Medieval cautery linked with a surgical care of a cranial blunt trauma wound is documented in Paleopathology and this case represents also one of those very rare instances in which direct evidence of ancient surgery can be gained from the skeleton examination.